Ep. 240 Fear-Free Keto with Amy Berger

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Episode 108 with Amy Berger

Transcript

Cynthia Thurlow: Welcome to Everyday Wellness Podcast. I’m your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent are to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
Today, I had the honor of reconnecting with Amy Berger, last podcast I did with her was in 2020 and that was podcast 108. Amy has a master’s degree in human nutrition. She is also a certified nutrition specialist as well as a U.S. Air Force veteran. She is also the author of many books including a coauthored book with Dr. Eric Westman called End Your Carb Confusion. I asked Amy to join me today so that we could dive into reducing fear, worry, and anxiety related to nutrition. She specializes in keto without the crazy keeping things sane and simple. And I think in our post-pandemic timeframe, it is a message that is woefully underrepresented. We spoke at length about the impact of food addiction and binge eating as well as orthorexia, the role of metabolic psychiatry, which is an emerging trend in medicine, the impact of brain health and blood sugar, different types of fuel substrates, weight loss resistance, and some keys into lesser-known issues that can intersect with this. The role of biohacking gadgets, the scale, and the value of food budgets. I hope you will enjoy this conversation as much as I did. Amy is a wealth of information; her YouTube channel is one of my favorites. There is just so much down-to-earth messaging in her brand and in her business.

Amy, it’s so nice to have you back on the podcast. I’ve really been looking forward to reconnecting with you.

Amy Berger: Yeah, thanks for having me.

Cynthia Thurlow: Now, you have a mantra that I really think of when I think of you. And you use the mantra, “Keto without the crazy, keeping things sane and simple.” And I would imagine this is in response to the antithesis of that, but where did that stem from? Was it dogmatic principles that you felt people were ready to die on the sword over? What drives that methodology?

Amy Berger: Yeah, this Keto Without the Craze. I didn’t sit down and brainstorm a catchphrase or anything. I was recording a video for my own YouTube channel at one point, and it just came out. And I said, “Oh, my goodness, I’ve got to keep that.” But the reason I think it speaks to me so much, and I think to other people is, like you said, there’s so much sensationalism in the keto world right now. And if you were brand new to this, you would think that this is building the space shuttle or something. It’s so complicated. There are so many moving parts. It’s a full-time job to follow a keto diet. And the truth is no, “it’s actually very, very simple and straightforward.” But not many people are telling you that you wouldn’t know it by getting on YouTube today, or by getting on Twitter or Instagram, you would think it’s like performing brain surgery.

[laughter]

Cynthia Thurlow: Well, for me, it’s interesting as a clinician to watch a lot of these nutritional dogmas become popular and people have great success with low-carb and ketogenic diets. But it’s almost the zealots and the strongly dogmatic individuals are in many ways creating further anxiety and stress for individuals that are just trying to navigate, in many ways, maybe their first attempt at a more simplified version of what they’ve been doing. And by that, I mean, I always say well-meaning people don’t realize that some of the things they say like “Unless you do carnivore, you’re going to have inflammation, unless you do keto, you’re never going to lose weight.” And if there’s a little bit of bio-individuality, but we also have to present things in a way that make them accessible and attainable and allow people to be successful with them without fear-mongering.

Amy Berger: Yeah, fear is the right word for it. There’s so much fear and worry and anxiety that people have about food. And I think, in my opinion, one of the nice things about low carb or keto is/or rather should be that you can finally lay all that aside. How many people come to keto or low carb or even paleo whatever version of this? How many people come to that? Because they’ve already tried the other stuff in the past, they tried veganism or they tried counting calories and counting points and they’ve already spent the last 10, 20, 50 years living in fear of food or living in fear of gaining weight or of not losing weight. I wish I could telepathically let people know there is a way of doing things that you can relax about that. And like you said everyone’s different, it’s not that you won’t have to tweak and tinker a little bit to find what works best for you as opposed to somebody else. But for most people, the starting point of just cutting way back on carbs is going to get you so far.

Cynthia Thurlow: I think that’s really important for people to understand. There’s a program that I run, and I explain to people that the average American is eating 200 or 300 grams of carbs a day. And if you just reduce your carbs to under 100, which for a lot of people is a massive shift that alone can be hugely impactful. I have people that will say, “well, it should only be 30 grams of carbs a day, and it should be under 50 grams of carbs a day, and I explained that for some people that’s not attainable, it will never be attainable, it’s and it’s not something that they can then sustain.” I think we’re in agreement that we want strategies that are sustainable, that are flexible, that allows people to have their lives and not feel so rigidly dogmatic about what they’re doing that they can enjoy a celebration or they can’t go out to dinner, or they’re fearful of inviting guests over because they perceive that their way of eating is too restrictive even if it isn’t. So, that’s why your message really resonates, and for people that follow you on Twitter, you call out the dogmatism you don’t, per se, poking a finger at anyone in particular, but you’re like, “This is not realistic, this is not sustainable.” For you observing things and you’re very analytical, you have a wonderful blog, you have a great YouTube channel. What have you seen over the last several years during the pandemic in terms of people’s shifting perspectives about nutrition or lack thereof what are you hearing from your clients?

Amy Berger: Yeah, thank you for all those kind words, by the way. And before I get into that, during the pandemic, what you said is so important, it doesn’t matter how effective any particular diet or other lifestyle change is, if somebody can’t actually do it, if they can’t actually implement it and stick to it, it doesn’t matter how well it works. What can that person do? How far can we get them, let’s do that, and not worry about? Well, you should be doing X and Y on top of this. And I think we probably both feel this shift eating should make your life better and more enjoyable and more free, free you up to do more, not box you in and limit. You don’t want to go out to a friend’s house because “Oh, they might have cooked something in the wrong oil or they might have I don’t know what?” This is supposed to make things better, not worse and more restrictive. But it’s interesting, the last couple of years, I think people have gone in one of two directions. They either use this time– and most of the world is open now like it was before. But when everything was more closed down, some people use that time to refocus like, “Oh, this is great, I can’t dine out as much, I’m going to cook more from home, I could even exercise for free on my living room floor. I can do push-ups or something. And then some people of course went the other way. I’m so stressed out, I’m so afraid of everything or they may have had increased burden, “Oh, my mother is elderly, I have to do her grocery shopping or order online for her” and they were sort of soothing and comforting with food or with alcohol, everyone joked that all the gyms closed down, but the liquor stores were open. I have no opinion on that one way or the other. I’m a wine lover.

But it went in two different directions. I think it’s a teachable moment. I hate that phrase but you can show people that this happening in the world is not an excuse to eat junk, “Okay, so everything shut down, therefore you have to eat cake therefore, you have to binge drink every other night.” How does that thinking come in? We all still bought groceries, you still could have cooked all your meals, you could have taken– and that’s not blaming or shaming, it’s help people see that– because whether it’s COVID or not, people say well I was doing really well, but then life happened, somebody passed away or there was a divorce or you got injured somehow. And again, I’m not saying of course there’re reasons we turn to food for comfort, but we could have also not turned to food, because something is always coming at us. We have to learn how to navigate life while still just eating what we normally eat and not making some big thing about it.

Cynthia Thurlow: I think that’s really important, the reframe, really understanding how do we process uncomfortable feelings. This is something that really becomes to the crux for each one of us. I mean, no one is perfect. There’s no one listening that hasn’t experienced, wanting or desiring whether it’s ice cream or chocolate or French fries, or whatever it is you’re drawn to when you’re stressed. The understanding that at the basis of a lot of that is uncomfortable feelings that many people are not ready to process, they’re not ready to deal with. And I would agree with you that part of the reframing for us in my family, I have two teenagers and two dogs, and my husband and I did a lot of walking because sometimes the only thing we could do is walk the dogs. The running joke was during the pandemic, what happened, all the dogs were “Stop walking us so much” because you couldn’t do a lot of other things. But I do think it’s important to understand that we will always have stress, that’s not going away. So, how do we manage and mitigate those feelings?

Now, one thing that, I was at an event this past weekend, and Dr. Tro, who we both know was talking quite a bit about food addiction and binge eating. And I think about that and I also think about the other side, orthorexia, people who are afraid to leave their homes because they’re, as you mentioned, seed oils or high fructose corn syrup or whatever they’re concerned about. How do you help people navigate these waters? I mean I fully understand and appreciate neither one of us are a clinical psychologist. But more often than not, a lot of what we see when people feel they’ve lost control about food is that they’ve got this underlying propensity for whether it’s food addiction or binge eating or they’re then so overtly concerned, they can enjoy their life because they feel they have to prepare everything in their house themselves, which is no way to live to feel you can’t enjoy food as opportunity to connect with others.

Amy Berger: Yeah, oh, my gosh, we are so on the same page. Because, we see both extremes and I think my keto without the crazy may have also come out of that, because we are aligned with the kind of eating, we’re aligned with whether you want to call it keto, or low carb, or even whole food, whatever you want to call it. Naturally, people are drawn to us who are very, very concerned about their health, about food quality, about the kinds of things they eat. And they do take it to that extreme that orthorexia, where it’s actually like I was saying before, keto, is low carb, it’s supposed to improve your life make it– not just physically but mentally, emotionally. And when you take it to that extreme, it’s making your life worse, it’s giving you all this anxiety and all this terror. And you’re right, I’m not qualified to help in some of these areas. Sometimes depending on the severity, I will refer to a mental health professional. Sometimes I just help people see, “is that how you want to live? Do you want to live in such a way that you can’t go to a party at a friend’s house or you can’t accept a gift or food or something, you can’t travel?” And that the biggest thing though is helping people see that again, especially if you have metabolic syndrome, or obesity, or type 2 diabetes, or PCOS. The number one most effective thing you can do is cut back on your carbohydrate intake. And that alone can go miles and miles.

I work with Dr. Eric Westman, we wrote a book together. He’s been doing this for 20 years in his clinic, he doesn’t tell people don’t eat the storebought salad dressing, don’t eat this mayonnaise, he just talks about the carbs. And they can lose 100 pounds, they can reverse all their illnesses, and I’m not saying that’s for everybody, but start there. And then if you want to pay a little more attention to the oils you use, or buying from a local farm, that’s great. But if you can’t do all of that at once, the orthorexia thing, maybe some type of compound as a problem, maybe it’s not. There are some people use aspartame, and they have no issues. And I know that’s, “Oh, I just stepped on the third rail of health, they’re talking about artificial sweeteners.” But you have to pick your battles, how many things do you want to worry about your food alone? Because what about the rest of your life? How much emotional energy do you want to devote to food?

Cynthia Thurlow: I think that’s such an important point. And ironically, about a month ago we saw this on Twitter, this study came out about non-nutritive sweeteners. And I actually discussed this study with my groups, and I discussed it with my coaches, and I just explained this is just it gives you “huh,” it impacts insulin sensitivity, it impacts glucose tolerance, it impacts the gut microbiome. What does that suggest we do? Limit, it doesn’t say you can’t ever use a sweetener or non-nutritive sweetener, but that’s the methodology. I mean that’s where a lot of people’s brains have gone that “Oh, this means all sugar is bad, all non-nutritive sweeteners are bad.” And I love that you bring up Dr. Westman’s work and your most recent collaboration is really an excellent resource. But I think it’s all about how nuanced you want to be because for some people that are eating a hyper-palatable highly processed diet that’s high on refined carbohydrates, low on protein, wrong types of fats, if the first thing that they can do successfully is reduce their carbs, then that’s fantastic, especially with the degree of metabolic disease that we see here in the United States. And you touched on, I know you have a background, talking quite a bit about brain health, Alzheimer’s, dementia risk, cognitive improvement or not, let’s pivot the conversation and speak there, because I think as I get older cognitive support and thinking about brain cognition in a proactive manner is an area of focus. And I think it is for a lot of listeners as well, we may not be able to be as tangible about a lot of other things, but brain health is something we can all relate to.

Amy Berger: Yeah, well, before I do that I want to say just because of what we were talking about before, there’s no right or wrong, right? There’s only what works and what is successful for somebody. And if somebody out there listening or watching is including a certain food item in their diet and they’re happy they’re getting the results they want, then don’t let someone scare you away from that if they’re single, you shouldn’t do this finger-wagging, you shouldn’t do that. If it’s working well for you, there’s really no right or wrong. There are no rules, this isn’t commandments, it’s your body and we’re all different. The brain, I think, not enough air time is given to how much the blood sugar and insulin problems affect cognition and affect the brain, we know or we take for granted that they affect the whole rest of the body in regard to weight gain or loss, in regard to diabetes and prediabetes, PCOS, non-alcoholic fatty liver, even skin tags, gout, all of these things. And we forget what is that doing to the brain? What are all these metabolic problems doing to the brain?

Cynthia Thurlow: Yeah, it’s a huge issue. And it’s interesting I interviewed Dr. Chris Palmer recently, and he was talking about dietary changes related to metabolic health and mental health. And, for me, I think a lot of people make this presumption that their brain is in a bubble from the rest of their body and that there’s no [unintelligible [00:17:19], there’s no blood-brain barrier, there’s no way you’re having any of these issues, and so let’s talk about some of the disorders that are common like anxiety and depression and bipolar and schizoaffective and things that we know there’s a connection with metabolic health. There’s a connection with mental health and nutrition because I think this is significant. I think on a lot of levels as someone who’s traditionally allopathic trained, the way that I learned mental health issues years ago, I think so completely differently about it and nutrition really is the way in many levels to improve brain metabolism, cognition, etc.

Amy Berger: Yeah, there’s an emerging field, now, they actually call it metabolic psychiatry. I think at Stanford University, they have a website for it, you can look it up, metabolic psychiatry. It’s so fascinating that we tend to think that these things are all in our head, “Oh, it’s just because of your thoughts or something or it’s a response to trauma.” Sometimes that’s true, but it is astounding how many mental health issues can get better when you change your diet. Sometimes that strict keto sometimes not, but it’s Dr. Brian Lenzkes out of San Diego gave a talk at a conference I was at recently and he showed the data from a CGM in one of his patients. And this woman was having panic attacks or what she thought were panic attacks turns out each time she was feeling that way it was hypoglycemia. I think that is probably true of millions of people who have panic attacks or anxiety problems or that sort of rumination. Depression, in some people, looks like it could be almost a depressed brain metabolism if you can get more energy to the brain but that’s not true for everybody. I know people with depression who are on you know keto doesn’t fix everything. But I wish I could be wrong, but I wish you know that it’s not already standard practice. But when you go to a psychiatrist, an MD, who can prescribe. I wish that before a medication was given, they should be doing an immense workup in terms of blood and biochemistry analysis like, “Are you anemic? Are you iron deficient,” that could cause depression, “Are you fatigued? Do you have some imbalance somewhere that is easily corrected with diet? Do you have insulin resistance, you have undiagnosed metabolic syndrome or diabetes, and that’s affecting the fuel getting to the brain.” It is so powerful and so promising. And again, it’s not going to get a magical cure for everybody but the side effect of changing your food is that you get to eat delicious food and feel good. Unlike the medications that come with this long list of scary side effects, the side effect of changing your diet is that you get to enjoy it.

Cynthia Thurlow: I think that’s really significant, and it’s interesting when I was pivoting away from cardiology, and the doctors I work with were semi-supportive of what I was doing. They’re like “Oh, this is the NP who thinks food is important.” And the more I recognize and realize that it’s one of the most important things we can do, not just for physical health, but also for our mental health. And I love that, this emerging field is something that will change the trajectory of medicine in hugely impactful ways. Now when we’re looking at fuel substrates, so if we’re looking at glucose and fatty acids and ketones, what is unique about ketones and the brain that can improve our mental health and mental clarity?

Amy Berger: Well, I don’t know that there’s anything unique to the ketones except that in the brain, for example in Alzheimer’s the problem in the brain in somebody with Alzheimer’s is that the neurons are no longer taking up and using glucose properly. I tell people it’s your brain is starving, it’s just a fuel shortage. And even though that grain is not taking up and using glucose, it will take up and use ketones. So, you’ve got this fuel, I don’t know that it’s necessarily a better fuel, it’s just an alternative fuel that the brain can use when it’s not using glucose as well. I do think though, the ketones, this is the simplified version, but they’re cleaner burning fuel, they produce fewer of those reactive oxygen species, and you get molecule for molecule, I think, when you burn, could be fatty acids maybe not ketones, you get more ATP, you get more energy. So, it’s just an even more powerful way, potentially, to fuel the brain. We know Alzheimer’s is an end-stage thing. Look at all the people who have brain fog, who go on a low-carb diet, and it’s somebody flipped a switch. And I don’t think there’s a whole lot of published research on that, but how many 1000s of clients and patients and anecdotes are there of people saying that that’s definitely something they’ve experienced, sharper thinking?

Cynthia Thurlow: Yeah, it’s interesting because for a lot of women, they’re at reduced risk for a lot of health issues including cognitive disparities until they go through menopause. In your patients, do you see as they’re transitioning from maybe perimenopause into menopause or men transitioning into andropause? And yes, men, that does actually happen as much as men don’t talk about it. Do you start to notice some cognitive improvement or deficits that you’re starting to observe in your client population?

Amy Berger: Most of the people don’t have those issues yet when they come to me, but I would say most of them report sharper thinking, no brain fog, and even more physical energy, they don’t need that afternoon nap, or they don’t have that afternoon dip anymore, I think most people notice. But if they had an issue, some people don’t have any sort of brain fog or anything, but if they do, I think they notice it getting much better.

Cynthia Thurlow: Oh, yeah, it’s amazing because it’s such a fairly and I say fairly simple, it’s all relative to what your experiences are about less carbohydrates, more energy, improved cognition, less brain fog, I mean that to me alone, knowing that you can get through your day without nap or needing that triple espresso with a soda and a candy bar, and Lord knows whatever else people are doing to try to keep themselves awake and alert while they’re at work or during their personal life. No it’s interesting, one of the most common topics that comes up in this podcast when I ask listeners and I mention who I’m connecting with, is weight loss resistance. I would imagine this is probably a very popular topic for you as well when you’re starting to unpack that for your clients. What are some of the common reasons why this happens? And part of why I’m asking this is that I know you have a unique lens on this and so it’d be interesting to talk a little bit about nutrient deficiencies and digestive function and some of the less commonly discussed reasons for weight loss resistance that we discuss on the podcast.

Amy Berger: Yeah, oh, my gosh, I have a book about this, actually, it’s called The Stall Slayer. People can find it at stallslayer.com. It’s about breaking fat loss stalls on low-carb diets. If you want me to go specifically for the less common things. There’s something that’s very, very common, but people don’t know how common it is. And that’s suboptimal thyroid function. I’m actually working on my next book now, it’s going to be about thyroid. It’s not a keto book, it’s going to be a thyroid book. And there’s just way, way too many people and it’s mostly women, but men can have thyroid problems, but it’s about a 9 to 1 ratio with women being affected more than men, so many people have low thyroid and they don’t know it because their doctor has been telling them for years your thyroid is normal, it’s not your thyroid, or they know they have a thyroid problem and they’re taking medication, but they’re on the wrong medication. And I’m not a doctor, but it doesn’t take an MD to read the research and to read the literature. There are way too many people taking Synthroid or levothyroxine, which is T4 only. And if your body’s not converting into the T3, you are still going to have all your same hypothyroid signs and symptoms including weight loss resistance. You will have a very hard time losing weight even on a low-carb diet, even with exercise, you can’t keto your way out of low fat. Some people who start off with a thyroid problem go on a low-carb or keto diet and it fixes, some people it doesn’t and you just need the hormone medicine.

Cynthia Thurlow: Well, it’s interesting because I myself have very stable Hashimoto’s thyroiditis never had positive antibodies. But I myself have been on this journey for about three years trying to get the right medication because things get discontinued whether it’s the Nature Throid or Armour Thyroid, and then being paranoid of taking synthetic hormones God forbid Synthroid, Cytomel, which is the synthetic T3. Perhaps it’s important for you to work with someone that is knowledgeable about thyroid physiology. And I think that conventional approaches miss opportunity. You mentioned if someone gets put on Synthroid because they’re hypothyroid, their body can’t convert the inactive form of thyroid hormone to active, they still feel significantly hypothyroid, and that there are all these other variables that impact thyroid function. I think a lot of people don’t understand it can be adrenals, it could be substantial mitochondrial dysfunction, it could be cofactors that you just don’t have and even if we’re eating an organic healthy diet, the mineral content of the soils are so depleted that we’re not getting same amount of minerals. And so, there’s so many things that can impact thyroid function quite significantly.

Amy Berger: Yeah, I think for a lot of women it’s self-induced, but they don’t know it’s years and years of calorie restricting, overexercising, too much stress, of course that’s going to happen, your body is doing you a favor by slowing you down, forcing you to slow down by lowering your metabolism. Again, that’s none of us meant to do that to ourselves. But that’s the end result after years and years of the pedal to the metal, eventually your body won’t let you do that anymore. I don’t want to neglect some of the other things, but I wouldn’t say this isn’t uncommon, but other reasons for the problems with weight loss. Some people are on medications that interfere with weight loss. Usually a low-carb diet will still work, it’s just going to be much slower or you may not lose all the weight you want to lose. But the good news is, the healthier you get, you might be able to reduce or stop taking some of those medicines eventually. The other one I think if the diet is right, if the carbs and the fat, if all of that is right, and the medicines taken care of. And I always look to that first. If somebody’s really struggling to lose weight, first I’m going to look at the diet. What exactly are you eating? And then I’ll look to the medicine, look to the thyroid, if these other things are lower down on my list of suspects of what’s the problem, sleep, I really do think when you don’t sleep enough and ask me how I know everybody, when you have poor sleep or you don’t respect your body’s need for sleep, that does interfere because it actually alters your hunger and appetite hormones, it alters your insulin sensitivity the next day, if you have poor sleep, once in a while is fine. But if we’re talking every night for months or years on end, we all have a bad night once in a while, but I still think you can get around that if everything else is on point, the diet, everything else, but the more things that are not, really hitting the mark, then they’re all going to come together to make it harder.

Cynthia Thurlow: I agree and I think sleep is just so foundational to our health, and certainly I also think about stress, you mentioned the yo-yo dieting, the overexercising, I would thrown over-fasting. I call it the triad because as an example, I have a group that I run a couple of times a year and these are women that are new to fasting and we’re walking them through this process. One of the questions was I consumed 900 calories a day, I can’t lose weight? Why is this the case? And so, trying to have to having a conversation about hormetic stress and hormesis. And if your body perceives you’re under a lot of stress already and then you’re adding in, it’s like gasoline, adding in the fasting and the overexercising and I’m going to restrict my food intake. And I think a lot of people just don’t realize that this intrinsic desire to lose weight can sometimes get us derailed from doing the work, I do believe fervently, we have to get healthy to lose weight, that that’s important and that’s part of the process, I’m not a fan of Seco but calories in calories out, it’s all the law of thermodynamics, and our bodies are far more sophisticated than that. Do you see a lot of men and women that assume that if a little bit of fasting is good, more is better. If a little bit of carbohydrate restriction is good, more is better, if a little bit of exercise is good, more is better that methodology and that mindset that can be very destructive.

Amy Berger: I see that all the time. [laughs] But you can understand it right? In this society, we’re so obsessed with weight, we’re so obsessed with size. We’re so desperate to lose weight, like some people, that’s been their goal in life. Their whole life, I just want to be thin again ask me how I know, how many years did I spend feeling that way. My whole goal in life was to just lose weight or fit into a size 6 or whatever it was. I understand the desperation, but yes, sometimes going too much will work against you. You know that overexercising, not respecting your need for rest, and your fueling, again, you can do anything if everything is properly managed. If you want to exercise a ton and great, but you better be giving your body enough calories, enough food to sustain you. And enough downtime and enough rest to sustain that. You can’t just push and push and push. And I was listening to someone else recently who was saying that she was exercising a lot and at one point she was burning out and she said, I think today it’s healthier for me to take a nap than it is to go work out, you should sometimes, you are better off prioritizing the rest than the workout.

I don’t care if it means you end the streak of X’s on your calendar, you’re better off skipping the workout that day and go to sleep or go for a walk in the fresh air. Some people consider that exercise, but let’s say you’re supposed to do some heavy-hitting, intense, crazy thing. Let’s say instead you go for a walk or something like that. I think we are so conditioned to more is better, harder is better, faster is better. It’s not always, sometimes you do need to step back and slow down. We feel guilty when we do right, we feel I should be working out, I should be– says who?

Cynthia Thurlow: I think that’s an important distinction. And where do you think all of this stems from? Do you think it’s the influence, obviously now of social media, but you and I– that came after? But do you think that starts at home with family conversations we have with our loved ones? Is it social pressure? Where do you think that stems from that desire to be a certain size? Step on the scale and have you effortlessly lose weight without you know really making an effort? Where do you think that comes from?

Amy Berger: I have no idea. In some people, it’s the family, there was a lot of pressure to look a certain way or for some people, I think it is just being steeped in the culture. I was born in 78. So, even before then, I guess there was Twiggy or whoever, but growing up seeing those kinds of magazines, all these women’s fashion magazines, and everybody is thin as a rail. I don’t know, I think it’s different for everyone because my family at least never put any pressure thank good– I mean, I put so much pressure on myself to be thin and to lose weight. I don’t know how much worse it would have been if my mother was breathing– now my mother was heavy. I think she was careful not to say anything to my sister and I when we grew up, but I think it’s different. It probably comes from different sources for a lot of different people, it is destructive. This is what sets people up for a lifetime of yo-yoing or restricting or you know how many women have we both– and men are not immune, but it’s more common in women. How many people have we worked with where they dismiss every– well I’m a PhD here, I’m a college graduate, I’m a great lawyer, I’m a great doctor, I’m a great plumber, whatever, but nothing matters and I’m a giant failure because I’m heavy. I’m a great mom, I’m a great wife, I’m a great this, but no, I’m a mess because whatever, I’m obese, this controls people.

Cynthia Thurlow: It definitely does and I asked the question because I’ve just been observing behavior on social media as of late. I have boys, but I also have nieces and I just wonder what this generation is going to grow up thinking is normal. There’s heavily filtered, heavily photoshopped photos, you and I grew up with, periodicals and magazines and newspapers when people didn’t have access way before the precedent of the internet access. And so, it makes me wonder what are those outside exterior influences and I agree with you, it’s probably a myriad of reasons. I think it’s probably some degree of susceptibility. There are probably some people that are more susceptible to that than others. I’ve had several girlfriends that have had anorexia and so, it’s been interesting as a clinician to observe their behavior and how as an example that eating disorder is always at bay. I mean it’s always around, it’s never gone away. And how they’ve navigated growing up having children, investigating their own relationship with food as an adult. And it’s not something that ever really goes away, I can just imagine, now, you’ve kind of alluded to on social media about gadgets, a lot of biohackers and gadgets. And one of the things that you said that I loved was, you can be happy without tracking your sleep score, readiness level, step counts, heart rate variability, and ketones. And so, let’s unpack this because I fully admit so much of it is bio-individual, I love data, but I’m a nerd. I worked in medicine and so I liked metrics, but I acknowledge how many women I work with that it totally stresses them out whether it’s a glucometer, a CGM, a Whoop band, an Oura Ring, etc.

Amy Berger: I am not opposed to any of these wearable devices and trackers, but I want people to have a healthy relationship with them. I want people to understand how to interpret what they see, I’ve joked except it’s not really a joke, you should have to sit through a five-hour biochemistry lecture before you are allowed to wear a CGM or before you’re allowed to measure your blood ketones. You should understand how to interpret the numbers based on your food, your activity level, are you sick that day? Are you under the weather? All of these things can affect some of these glucose and ketone dynamics. And that’s just one example. I mean, you said the Oura Ring or these heart rate monitors. They’re all useful, they can all definitely provide educational feedback, and if somebody’s capable of using that as educational feedback to guide a behavior change, you’re like “Ooh, I thought I was okay eating the certain food. Ooh, clearly I’m not, it made my sugar drop 80 points, no more than for me.” But if you’re going to use it as a judge and jury and as a way to punish yourself like, “Oh, my God, I only got 12,000 steps today. I don’t know, I have a friend who has been wearing the Oura Ring for years. And I have an Oura Ring myself, I’m not bad-mouthing the ring, but here’s the behavior pattern. He’s been wearing it for years, he knows his patterns, he knows when he wakes up, what the ring is going to tell him how he feels. And he said this to me once he said, I don’t even have to look at it anymore. I already know. And I said, “Why are you still wearing the ring?” He already knows, he knows based on how he feels, how his sleep was, what does he need the ring to tell him? “Well, you got X minutes of REM sleep and X minutes of deep sleep.” And I have used the Oura like I said I have one, sometimes I wake up and I feel great. And I looked and my sleep was terrible and then the opposite. Supposedly I had a really good sleep last night, I feel like garbage. So, we don’t want to put too much stock like the danger of some of these devices is that we ignore how we actually feel. And we look at the number. Again, I think they’re useful, I’m not opposed to them, I want people to have a healthy relationship. It’s the scale is a whole separate one to step on the scale every day. It’s fine if you want to weigh yourself every day. But you can’t have that number determine your self-worth for the day. Oh, I’m up a pound, therefore I’m a failure, I don’t deserve happiness, I’m unlovable or you’re down a pound, “Oh, my God,” this stuff that is so much more difficult to help people with than the food. I can give anybody a food list, here’s what to eat, see you next time. This stuff is the hard part, I think.

Cynthia Thurlow: Yeah, I know, it’s ironic, because my next question was about the scale. What are your thoughts on the scale? I think that for a lot of people, it’s this retraining their mindset around whatever their focus is, I have had women come to me that say I want to weigh what I weighed 18. And I’m like “Great, that’s fantastic.” Is that realistic? Like is it realistic because probably back then you didn’t eat all that healthy and at this stage of life that wouldn’t serve you or people understanding that throughout their menstrual cycle, they may gain three to five pounds just based on fluid shifts, and what you eat the day before, if you ate a very carbohydrate-laden meal, it probably will show on the scale. I think it’s this retraining the relationship or using the scale as a metric, you’re going to weigh yourself once a week, I think that’s probably more helpful than living and dying by the scale, because that number, I always say the scale is a liar. I mean that’s the way that I think about it, that if we acknowledge that it doesn’t really show us the full clinical picture, then that’s much healthier than as you said, people they’ve lost 3 pounds, they’re thrilled, they’ve gained 2 pounds, they’re miserable for the whole day that sets the tone and their mood for the entire day.

Amy Berger: Well, you just said the most important thing, which is the number on the scale doesn’t give you the full picture. That is, I have to reprogram people about this all the time. That is your total body weight. That does not tell you how much body fat you have on your body. That is the total of everything. It’s the water, it’s the bone, it’s the organs, it’s the muscle mass, “Oh, and also the fat.” And like you said, not even during the menstrual cycle. For any other reason, the total weight can be up or down 2 to 3 pounds. And Dr. Stephen Phinney and Dr. Jeff Volek have written about this. This is not up for debate. The body just normally fluctuates. I know when it’s humid out, I retain water because I have rings that fall off me, they’re so loose. And when it’s humid out, I can barely even fit them on, my fingers were like swollen sausages. And people have to just understand that the fluctuation is normal. And it has nothing to do with you gaining or losing fat from day to day. And I think you said, weighing once a week is fine. I think weighing every day is fine if again you don’t let it ruin you for the day. And I think what I like to do is if I don’t want people to weigh every day, but if that’s what they’re going to do record it every day, but then look at the weekly running average. So, it’s as if you’re weighing yourself once a week. So, the trend, is it trending downward over time, because it’s a squiggly line, even when you’re doing everything right, there’s going to be times where the weight stays the same or you’re up a pound or 2, then it down, just stay the same, it’s down again, it’s up. It’s a squiggly line as long as over the long term the squiggles going downward. And the other thing, nobody believes me until it happens to them personally, and you probably see this all the time too. In women, especially again sometimes in men, mostly in women, you can lose size without the scale changing at all just the way your body is changing and shifting, you can get smaller even though your weight either hasn’t changed or maybe it’s changed a lot less. And this happens all the time and again nobody believes me until they experience it for themselves.

Cynthia Thurlow: It’s absolutely true, there’s body composition shifts as opposed to weight loss can be significant and profound. What are your thoughts on budgeting for food? So, meaning this is a question that came up from multiple people, they’re concerned that if they start eating a more nutrient-dense whole-food diet, it is going to be expensive. Are there tips that you make suggestions that you make for your clients that would be of benefit? I think a lot of this stems around protein. I think that is a concern that eating a higher animal protein diet that is cost prohibitive and I don’t think that’s the case. I think people have to get creative.

Amy Berger: Yeah, I think depending on where you want to get your food from, local farm, Co-op, health food store versus the regular grocery store, you can absolutely eat this way without taking up second or third mortgage on your home. Think about all the things you’re not going to buy anymore. You’re not getting out some of this stuff is cheap, but you’re not going to be buying pasta and rice and potatoes and [unintelligible [00:44:09] potato chips and beer and all this other stuff that you’re not going to be buying. And so, you’re going to have that extra money or that same amount of money to spend on the other stuff and it’s not rocket science. Shop the sales. If ground beef is on sale, pork chops are on sale, chicken thighs are, stock-up, fill your freezer. For those who are not doing a carnivore diet. If you’re doing more, low-carb or keto, you know broccoli at the store I shop at is usually $1.48 a pound. Zucchini and yellow squash when they’re on sale, I don’t know 79 cents a pound, 99 cents a pound, this is dirt cheap, they’re practically giving it away. And I just think it’s not as big a deal as people think it is, a protein is a lot more expensive these days. That is the prices have definitely gone up. But you can still catch things on sale. Don’t eat filet mignon, eat ground beef, eat pork chops instead of, I don’t know what scallops and shrimp. I just think that’s the way to do it, like all the stuff you’re not buying and then this is only true for some people if they had an illness, how much are you going to save on all the co-pays to the doctors and all the medication and the procedures and stuff that you might not need anymore? But I just think what understanding that some people are very, very budget constrained, most of us have money for the things that we value, we really do. Maybe you get that fancy schmancy $6 coffee drink less often and put that money toward food or maybe you go out one time less a month, most of us have money for the things that we really want to prioritize.

Cynthia Thurlow: That’s such a good point and certainly one that I think for a lot of individuals, it’s recognizing a lot of our personal day-to-day decisions, impact our grocery budgets far more than we realize. Now one thing I wanted to touch on before we end our conversation today was I had touched on nutrient deficiencies. I had a guest recently and we did talk about this at great length. But one of the things that when I was prepping for this that I thought you did a particularly good job on was talking about how certain nutrients are really important for mitochondrial health. And my listeners are certainly very knowledgeable about the mitochondria. And in particular, things like carnitine and the B vitamins and magnesium, what do they do for the health of our mitochondria? And so, remember, these are the powerhouses of ourselves, it’s really important. It’s also important to understand, as we get older we’re much more prone to dysfunctional mitochondria. That’s why fasting in particular can be helpful for just mitophagy, autophagy, getting rid of these disease-disordered cells. But these nutrients in particular, what are some of the benefits for the mitochondria?

Amy Berger: Well, they are the powerhouses of the cell, they are where we generate the vast majority of energy, some energy can be generated outside the mitochondria for all BioChem geeks out there like, “We know it’s not all in the mitochondria.”

[laughter]

Amy Berger: But in that electron transport chain, the process that literally converts these chemicals into the ATP energy, we need the B vitamins, we need iron, we need vitamin C, there’s I think manganese is the mitochondrial superoxide dismutase, they help with antioxidants. They help literally transport the electrons through the mitochondria that generate the energy, literally if you looked at a diagram. These vitamins and minerals are essential components of that process in order for all of that to happen. So, why do we think, one of the biggest hallmarks of simply being unwell is fatigue, you literally are not producing enough energy. The B vitamins especially iron deficiency anemia is a big thing for fatigue. We just are literally at the cellular level not generating enough energy.

Cynthia Thurlow: And it’s interesting to me because magnesium is one of these things that people think about for sleep and they think about it for blood sugar support. And yet it’s interesting, if you look at a cellular level, what it’s actually doing, how it’s contributing to these biochemical processes. And yes, the biochemists are listening. We’re aware of all these other contributors, but we’re trying to make the information relatable to the average individual who didn’t go through pre-med classes in college and graduate school. But it’s interesting to me how it’s an endless amount of contributions for these cofactors. It’s not just for the thyroid, it’s not just to help with the mitochondria. There are so many cellular processes that go on and we really do genuinely need to be either getting these from food or getting them from supplementation.

Amy Berger: Yeah, but I think it’s interesting because of the human body is so robust that with as many people as are sick or have compromised health, it’s amazing that we’re all not walking around falling straight down with how things are today. But I also think it gives people hope to think oh my gosh, I have to have all these nutrients and do all these things. It’s actually pretty simple to get the right things and avoid the things that get in the way. And the human body is so resilient that you start making those shifts, you start getting what you need and getting rid of the stuff that’s standing in the way and it is so remarkable how much you can improve and we’ve both seen this all the time, people that are so far into the disease path, whatever it may be diabetes, PCOS, fatty liver, chronic fatigue, fibromyalgia, and they can feel so much better. Now, sometimes it takes a while for things to kick in. But I mean, we should just feel so lucky that we are able to come back from things. I mean that’s one of the most hopeful things I think is how far you can be and still actually make such a huge improvement. And we see it all the time.

Cynthia Thurlow: Well, it’s really exciting. And I’m grateful that we had an opportunity to meet in person this summer. And for all your contributions and your voice of reason and sometimes an insane social media space. Please let listeners know how to connect with you, how to connect with your blog, you’ve got all these wonderful books, we’ll definitely have to keep our eyes out for your upcoming book on thyroid function which will be really exciting, and “Stall Slayer.” I was not aware of that one, we’ll have to make sure we link all these things up so people can access this information.

Amy Berger: Yeah, thank you. My website needs an overhaul, but it’s tuitnutrition.com. But there is also stallslayer.com. I do a consultation, so people can find me there, there’s a button that says work with me. And my YouTube channel is also called Tuit Nutrition and that’s my handle on Twitter. And I do still work with Dr. Westman at his company where we do online courses about keto. We also have stuff about cholesterol and food addiction and that’s a very long name adaptyourlifeacademy.com.

Cynthia Thurlow: Fantastic, well, thank you again for your time today. I know this will be an invaluable resource and podcast for listeners.

Amy Berger: Thank you, thanks for having me again.

Cynthia Thurlow: If you love this podcast episode, please leave a rating and review. subscribe and tell a friend.